Data-driven development of the Meal-based Diet History Questionnaire for Japanese adults

Chrononutrition behaviors in relation to diet quality and obesity: do dietary assessment methods and energy intake misreporting matter?

BACKGROUND

Inconsistent epidemiologic findings on the associations of chrononutrition behaviors with diet quality and adiposity measures may be due to the use of different dietary assessment methodologies and a lack of consideration of dietary misreporting. We aimed to investigate the associations by using questionnaires and diaries, with adjustment for energy intake (EI) misreporting.

METHODS

This cross-sectional study included 1047 Japanese adults aged 20-69 years. We used the Chrono-Nutrition Behavior Questionnaire (CNBQ) or 11-day diaries to assess chrononutrition behaviors (meal frequency, snack frequency, total eating frequency, timing of first eating occasion, timing of last eating occasion, duration of eating window, and eating midpoint) for workdays and non-workdays separately. Eating jetlag was defined as the eating midpoint difference between workdays and non-workdays. Diet quality was assessed using the Healthy Eating Index-2020, based on the Meal-based Diet History Questionnaire (MDHQ) or 4-day weighed food diaries. EI misreporting was evaluated using the Goldberg cut-off principle.

RESULTS

Using questionnaire data (CNBQ and MDHQ), we found inverse associations of snack and total eating frequencies, timing of last eating occasion, eating midpoint, and eating jetlag with diet quality (P < 0.05), irrespective of adjustment for EI misreporting. Also, we found positive associations of meal, snack, and total eating frequencies and duration of eating window with the prevalence of general obesity (body mass index ≥ 25 kg/m2), abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females), or both; many of these associations were only evident (P < 0.05) after adjustment for EI misreporting. In contrast, using diary data, we found no associations between chrononutrition behaviors and diet quality, general obesity, or abdominal obesity, regardless of adjustment for EI misreporting (except for inverse associations of timings of first and last eating occasions and eating midpoint on workdays with diet quality).

CONCLUSIONS

The associations of chrononutrition behaviors with diet quality and obesity were dependent on the methodology used to assess these behaviors. Adjustment for EI misreporting radically changed only the associations with obesity in the questionnaire-based analysis. These findings suggest the importance of careful consideration of dietary assessment method selection and EI misreporting in chrononutrition research.

Relative validity of the Chrono-Nutrition Behavior Questionnaire (CNBQ) against 11-day event-based ecological momentary assessment diaries of eating

BACKGROUND

A growing number of studies have investigated chrononutrition-related variables in relation to health outcomes. However, only a few questionnaires specifically designed for assessing chrononutrition-related parameters have been validated. We aimed to examine the relative validity of the Chrono-Nutrition Behavior Questionnaire (CNBQ) against 11-day event-based ecological momentary assessment (EMA) diaries of eating.

METHODS

Informed by previous research, we developed the CNBQ for the comprehensive assessment of chrononutrition-related parameters, including sleep variables, eating frequency, timing of eating, duration of eating occasions, duration of eating windows, and time interval between sleep and eating, for workdays and non-workdays separately. Between February and April 2023, a total of 1050 Japanese adults aged 20-69 years completed the online CNBQ and subsequently kept event-based EMA food diaries for 11 days, including 6.5 workdays and 4.5 non-workdays on average.

RESULTS

Mean differences between estimates derived from the CNBQ and the EMA food diaries were < 10% for most of the variables examined, both for workdays (27 of 33; 82%) and non-workdays (25 of 33; 76%), and for variables based on differences between workdays and non-workdays, such as eating jetlag (5 of 6; 83%). Spearman correlation coefficients between estimates based on the CNBQ and estimates based on the EMA food diaries were ≥ 0.50 for 26 variables (79%) on workdays and 22 variables (67%) on non-workdays (e.g., mid-sleep time; total eating frequency; timing of first eating occasion, last eating occasion, first meal, and last meal; duration of first meal and last meal; duration of eating window; eating midpoint; and time interval between wake time and first eating occasion and between last meal and sleep time), and 2 variables based on differences between workdays and non-workdays (e.g., eating jetlag base on breakfast timing). Bland-Altman analysis showed that the limits of agreement were wide and that the bias of overestimation by the CNBQ was proportional as mean estimates of the CNBQ and EMA food diaries increased.

CONCLUSIONS

These findings suggest that the relative validity of the CNBQ justifies its use in estimating mean values and ranking individuals for the majority of chrononutrition-related parameters.

Relative validity of three diet quality scores derived from the Brief-type Self-administered Diet History Questionnaire and Meal-based Diet History Questionnaire in Japanese adults

No study has validated questionnaires for assessing easily calculable diet quality scores in Japan. The Brief-type self-administered Diet History Questionnaire (BDHQ) is widely used to assess dietary intake in Japan, while the Meal-based Diet History Questionnaire (MDHQ) assesses dietary intake for each meal (breakfast, lunch, dinner and snacks) and overall dietary intake. This study examined the relative validity of the BDHQ and MDHQ for assessing three diet quality scores in Japanese adults. A total of 111 women and 111 men aged 30-76 years completed the web MDHQ and BDHQ, followed by 4-non-consective-day weighed dietary records. The diet quality scores examined included the Diet Quality Score for Japanese (DQSJ), Dietary Approaches to Stop Hypertension (DASH) score and Alternate Mediterranean Diet (AMED) score. The means of the three scores for overall diet from the BDHQ were not significantly different from those from the dietary records in both sexes, whereas those from the MDHQ were higher than those from the dietary records, except for the DASH and AMED in women. Pearson's correlation coefficients between both questionnaires and dietary records were 0·57-0·63 for DQSJ, 0·49-0·57 for DASH and 0·31-0·49 for AMED across both sexes and both questionnaires. For each meal, Pearson's correlation coefficients between the MDHQ and dietary records ranged from 0·01 (DASH for snacks in women) to 0·55 (DQSJ for breakfast in men), with a median of 0·35. This study showed that the ability of the BDHQ and MDHQ to rank individuals was good for DQSJ and DASH and acceptable for AMED.

Dietary Intake Assessment Using a Novel, Generic Meal-Based Recall and a 24-Hour Recall: Comparison Study

BACKGROUND

Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods.

OBJECTIVE

This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR).

METHODS

Participants completed a web-based, generic meal-based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant.

RESULTS

In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6% (IQR 2.6%-13.2%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83%) variables, moderate for 2 (9%) variables, and large for 2 (9%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8% (85/161) to 84.5% (136/161).

CONCLUSIONS

A generic meal-based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall.

Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study

BACKGROUND

The advent of the internet has changed the landscape of available nutrition information. However, little is known about people's information-seeking behavior toward healthy eating and its potential consequences.

OBJECTIVE

We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources.

METHODS

This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations).

RESULTS

The top source of nutrition information was television (1973/5998, 32.89%), followed by web searches (1333/5998, 22.22%), websites of government and medical manufacturers (997/5998, 16.62%), newspapers (901/5998, 15.02%), books and magazines (697/5998, 11.62%), and video sites (eg, YouTube; 634/5998, 10.57%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95% CI 1.09-1.49) to 1.81 (95% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95% CI 1.62-2.44), books and magazines (OR 2.09, 95% CI 1.64-2.66), and video sites (OR 1.53, 95% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95% CI 1.01-1.03) and books and magazines (OR 1.03, 95% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites.

CONCLUSIONS

We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials.

The Nutritional Characteristics of Usual Lunches Consumed Among Japanese Workers: Comparison Between Different Lunch-Type Groups

OBJECTIVE

This study investigated whether the nutritional characteristics of lunches consumed by Japanese workers differ by where the meal is usually prepared or eaten.

METHODS

This cross-sectional study included 620 employees (aged 20 to 75 years) from eight business offices in Tokyo, Japan. Dietary data were collected using the validated Meal-based Diet History Questionnaire. The Healthy Eating Index 2015 and dietary intakes from lunch were compared between workers classified by usual lunch type: homemade (n = 190), staff canteen (n = 77), restaurant (n = 109), and takeaway (n = 244).

RESULTS

Healthy Eating Index 2015 for lunch was highest in the staff canteen group, followed by the homemade group. The staff canteen group had higher intakes of total vegetables, potatoes, fish, and several vitamins from lunch than the restaurant or takeaway groups.

CONCLUSIONS

Homemade and canteen lunches are relatively healthy options for lunch for Japanese workers.

Relative Validity of the Meal-Based Diet History Questionnaire for Estimating Nutrient Intake among Japanese Women and Men aged 30–76 Years

The purpose of this study was to examine the relative validity of the Meal-based Diet History Questionnaire (MDHQ) for estimating nutrient intake. Dietary data were obtained from 111 Japanese women and 111 Japanese men, using the online MDHQ and the 4-non-consecutive-day weighed dietary record (DR). The number of nutrients (total n = 46) showing no significant mean differences between estimates from the online MDHQ and DR (with energy adjustment by the density model) was 17 among women and 12 among men. The median value (25th and 75th percentiles) of the Pearson correlation coefficients between the online MDHQ and DR estimates was 0.54 (0.35–0.57) among women and 0.45 (0.25–0.53) among men. Bland–Altman plots for energy-providing nutrients indicated wide limits of agreement (and proportional bias for protein) with overall underestimation of protein and fat and overestimation of carbohydrate by the online MDHQ. Similar results were found when the paper version of the MDHQ (completed after the DR) was examined. For example, the median value of the Pearson correlation coefficients was 0.54 for women and 0.45 for men. This study suggests that the MDHQ has an acceptable ability to rank individuals according to intakes of a wide range of nutrients.

Relative Validity of Food Intake in Each Meal Type and Overall Food Intake Derived Using the Meal-Based Diet History Questionnaire against the 4-Day Weighed Dietary Record in Japanese Adults

We examined the relative validity of food intake for each meal type (breakfast, lunch, dinner, and snacks) and overall food intake obtained through the Meal-based Diet History Questionnaire (MDHQ). In total, 222 Japanese adults (111 for each sex) aged 30–76 years completed the web version of the MDHQ and then the 4-non-consecutive-day weighed dietary record (DR). The number of major food groups (n = 24 in total) for which no statistically significant difference was observed between median intakes estimated using the DR and MDHQ ranged from 8 (snacks) to 12 (dinner) among women, and from 8 (breakfast) to 13 (lunch) among men. The median values of the Spearman’s correlation coefficients between the MDHQ and DR estimates ranged from 0.28 (dinner) to 0.54 (breakfast) among women, and from 0.24 (dinner) and 0.60 (breakfast) among men. Bland–Altman analyses generally showed wide limits of agreement and proportional bias. Similar results were obtained using the paper version of the MDHQ, which was completed after conducting the DR. In conclusion, the MDHQ has a satisfactory ability to estimate median intake and rank individuals according to consumption for many food groups, despite a limited ability to estimate food group intakes on an individual level.

Web-Based Personalized Nutrition System for Delivering Dietary Feedback Based on Behavior Change Techniques: Development and Pilot Study among Dietitians

Given the complex and varied nature of individual characteristics influencing dietary behaviors, personalized dietary advice may be more effective than generalized “one-size-fits-all” advice. In this paper, we describe a web-based personalized nutrition system for improving the quality of overall diet in the general adult population. The development process included identification of appropriate behavior change techniques, modification of dietary assessment method (Meal-based Diet History Questionnaire; MDHQ), selection of dietary components, and a personalized dietary feedback tool. A pilot study was conducted online among 255 dietitians. Each completed the MDHQ, received his/her own dietary feedback report, and evaluated the relevance of the report based on 12 questions using a 5-point Likert scale from “totally disagree” (score 1) to “totally agree” (score 5). The mean value of overall acceptability score of dietary feedback report was 4.2. The acceptability score was, on average, higher in plausible energy reporters (compared with implausible energy reporters), participants who printed out the report (compared with those who did not), and those spending ≥20 min to read the report (compared with those spending <20 min). This is the first attempt to develop a web-based personalized nutrition system in Japan, where dietitians were broadly supportive of the dietary feedback report.